Method for measuring bile salt export and/or formation activity

ABSTRACT

A method is provided to measure modulation of bile salt export transport and/or formation activity in hepatocyte or stable cell line preparations by test agents including but not limited to drugs, drug candidates, biologicals, food components, herb or plant components, proteins, peptides, DNA, RNA. Furthermore, the method is to determine modulation of bile salt export transport and/or formation activity not only by said test agents, but further their metabolites or biotransformed products formed in situ. The bile salt export transport and/or formation activity modulation includes but not limited to inhibition, induction, activation and/or regulation. The method can be practiced to identify test agents, which have potential to cause liver injury, drug-drug interactions, and/or can be used as therapeutic agents for the treatment of cholestasis, abnormality of bile salt metabolism, liver diseases and cholesterol abnormality.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. Non-Provisional applicationSer. No. 15/675,388 filed on Aug. 11, 2018, which is continuation ofU.S. National Stage application number Ser. No. 14/781,520 filed on Sep.30, 2015, now U.S. Pat. No. 9,772,325 B2, under 35 U.S.C. § 371 ofPCT/US2014/041136, filed on Jun. 5, 2014, which claims priority fromU.S. Provisional application No. 61/834,944, filed on Jun. 13, 2013.

TECHNICAL FIELD

The subject matter disclosed herein introduces a novel method to measurethe modulation, by test agents on hepatic bile salt export transportand/or formation activity, in incubations of hepatocyte preparationsderived from human and animal livers or stable cell lines including butnot limited to HepG2 (hepatocellular carcinoma) with bile salt precursorcompounds and determining the post-incubation extracellular and/orintracellular bile salt concentrations. Test agents include but are notlimited to drugs, drug candidates, biologicals, food components,peptides, proteins, oligonucleotides, DNA, and RNA. Bile salt precursorcompounds, also known as bile acids, used in this invention includecholic acid, chenodeoxycholic acid, deoxycholic acid, lithocholic acid,and derivatives thereof incubated separately or in any combination. Bilesalts, also known as conjugated bile acids, measured in the inventioninclude glycocholic acid, taurocholic acid, glycodeoxycholic acid,taurodeoxycholic acid, glycochenodeoxycholic acid, taurochenodeoxycholicacid, glycolithocholic acid, and taurolithocholic acid, which can bemeasured separately or in any combination. Furthermore, this disclosedsubject matter relates to applications of said method for measuring testagent modulation of bile salt export transport and/or formation activityin screening paradigms for purposes of assessing potential treatmentsfor hepatic cholestasis, drug-drug interactions, and drug-induced liverinjury. A kit to facilitate screening test agents on modulation of bilesalt export transport and/or formation is provided.

BACKGROUND ART

Bile Salts: The production of bile is an important function of human andanimal liver hepatocytes and plays a crucial role in hepatobiliary andintestinal homeostasis and digestion. [de Buy Wenniger, Bile salts andcholestasis. Digest Liver Diseases 42(6), 409-18, 2010] Bile comprises ahighly concentrated solution of bile salts—also known as conjugated bileacids—biliary lipids (phospholipids and cholesterol) and electrolytes.[Kis et al., Effect of membrane cholesterol on BSEP/Bsep activity:specificity studies for substrates and inhibitors, Drug Metabolism andDisposition 37, 1878-1886, 2009] Bile salts are synthesized in the livervia a series of metabolic steps starting from cholesterol. Bile saltsand acids are secreted into bile and stored in the gallbladder forrelease. [Einarsson et al., Bile acid formation in primary humanhepatocytes, World Journal of Gastroenterology 6(4), 522-525, 2000;Jansen and Faber, 2.3.6 Metabolism of bile acids in Hepatology—FromBasic Science to Clinical Practice, Third edition, 2007, 174-181]

Bile salts or conjugated bile acids include glycocholic acid,taurocholic acid, glycodeoxycholic acid, glycochenodeoxycholic acid,taurodeoxycholic acid, taurochenodeoxycholic acid, glycolithocholic acidand taurolithocholic acid (see FIG. 1).

After a meal, the gallbladder contracts, and stored bile is secretedinto the intestinal tract where it plays a key role in the absorption ofdietary lipids, fat-soluble vitamins, nutrients, and some drugs and drugcandidates. In the intestine, approximately 90-95% of secreted bilesalts are reabsorbed and returned to the liver and taken up there byhepatocytes—a process called enterohepatic circulation. [Jansen andFaber id. page 174] Enterohepatic circulation serves an importantphysiological function not only for the recycling of bile salts andabsorption of dietary lipids, fat-soluble vitamins, nutrients and somedrugs and drug candidates, but also for the regulation of whole-bodylipid metabolism. [Chiang, Bile acids: regulation of synthesis. Journalof Lipid Research 50, 1955-1966, 2009]

Bile salts are indispensable for the formation of bile flow; secretionof cholesterol and phospholipids from the liver, formation of mixedmicelles that keep fat-soluble organic compounds in solution in the gut,promotion of the dissolution and hydrolysis of triglycerides bypancreatic enzymes, and act as signaling molecules in the regulation ofenzymes and transporters of drugs and intermediary metabolism. [Jansenand Faber, id. page 178]

Biosynthesis of bile salts involves a multi-step process beginning withthe initial oxidation of cholesterol by cytochrome P450 oxidase enzymes(also known as mixed function oxidases) present in human hepatocytes.(FIG. 2) [id. page 174, Chiang id. page 1955] Two main routes exist forthe conversion of cholesterol to the primary bile acids cholic acid (CA)and chenodeoxycholic acid (CDCA):] a classic or neutral pathwayinvolving initial oxidation by the cytochrome P450 CYP7A1 (cholesterol7α-hydroxylase) and alternative or acidic pathway involving side chainhydroxylation with cytochrome P450 CYP27A1 (sterol 27-hydroxylase).[Jansen and Faber id. page 174] CYP7A1 is regarded as the rate-limitingenzyme in bile acid synthesis and deficiencies in animal models havebeen associated with severe liver failure. [Jansen and Faber id.] TheCYP27A1 product is not a substrate for CYP7A1 but instead is oxidized byanother cytochrome P450 enzyme named CYP7B1. From there, the neutral andacidic pathways overlap producing CDCA and CA. Other minor oxidativepathways may also contribute to bile acid synthesis. [Jansen and Faberid.] Most bile acids, including CA and CDCA, are conjugated to the aminoacids glycine (G) and taurine (T) by two enzymes: bile acid:CoA synthase(BACS) and bile acid:amino acid transferase (BAT). [Chiang id. page1957] These glycine and taurine bile acid conjugates act to decrease thetoxicity and increase the aqueous solubility of unconjugated bile acidsfor secretion into bile. [Chiang id. page 1957] In the intestine, theglycine- and taurine-conjugated CA and CDCA can be deconjugatedreleasing CA and CDCA, which can be acted on by gut bacterial7α-dehydroxylase to remove their 7α-hydroxy groups and thereby producethe secondary bile acids deoxycholic acid (DCA; 3α-12-dihydroxy CA) andlithocholic acid (LCA; 3α-monohydroxy). [Chiang id.] CA, CDCA, and DCAcan be reabsorbed in the intestine and transported back to the liver toinhibit bile acid synthesis. Most of LCA is excreted in feces. Thereabsorbed bile acids are further conjugated to amino acids producingthe bile salts of CA, CDCA, and DCA.

Amino acid conjugated bile acids are termed conjugated bile acids orbile salts while non-amino acid conjugated bile acids are termed free.Bile acids and salts can be potentially toxic to cells and theirconcentrations under physiological conditions are tightly regulated. Asmentioned above, bile acids are important and potent signaling moleculesin the liver and intestine. Both free and conjugated bile acids bind tothe ligand-binding domain of the nuclear transcription factor famesoid Xreceptor (FXR; NR1H4), regulating FXR and associated gene transcriptionproduct FGF19 and ultimately regulating bile acid synthesis, excretion,and transport. [Chiang id. page 1956] Additionally, free and conjugatedbile acids have been found to bind and activate pregnane X receptor(PXR; NR112) and vitamin D receptor (VDR; NR1|1). [Chiang id.]

The process of producing bile salts essentially results in theconversion of the hydrophobic cholesterol molecule into an amphipathicmolecule that can serve physiologically as a detergent for absorptionand transport of nutrients, fat-soluble vitamins, drugs, and otherchemicals.

Bile salts have important acid-base properties, especially in theintestinal duodenum where pH values range from 3 to 5 units. [Costanzo,Physiology, 4^(th) edition, Saunders/Elsevier, Philadelphia, Pa., 2010]Unconjugated bile acids have pKa values ranging near 7 pH units. In theduodenum, unconjugated bile acids are almost exclusively in theunionized protonated form and therefore are relatively insoluble inwater and readily reabsorbed by the intestinal epithelium cells. Bilesalts or conjugated bile acids have much lower pKa values ranging from 1to 4 units whereas the conjugated bile salts are ionized or deprotonatedin the duodenum, are more water soluble, and are more able to emulsifylipids and other non-water-soluble agents.

Bile salts or conjugated bile acids in the duodenum having been ionized,are not readily reabsorbed and can build up in concentrations to allowfor formation of micelles and solubilized lipids which play significantroles in processes such as elimination of cholesterol from the body,removal of catabolites produced by the liver, and emulsifying lipids,fat-soluble vitamins, and some drugs and drug candidates. [Jansen andFaber id. page 178]

Hepatocytes: Hepatic parenchymal cells, or hepatocytes, are polyhedralor spherical in nature and account for approximately 60% of the cells inthe liver; they represent 80% or more of the total liver volume. [de laIglesia, Morphofunctional aspects of hepatic structure, Handbook of DrugMetabolism, edited by T. F. Woolf, 1999, page 83] Hepatocytes are polarin nature and one skilled in the art would recognize what is termed anapical (canalicular) membrane or domain and a basolateral (blood orsinusoidal domain) membrane or domain. The hepatocyte basolateralmembrane or domain is involved in the uptake of drugs and xenobioticsinto the cell, while the apical membrane or domain provides a route forintracellular produced bile salts to be excreted or transported intobile flow and eventually to the common bile duct for secretion into theintestine.

Hepatocytes have specialized transport systems or transcellulartransporters located at the basolateral membrane and the apicalmembrane. [Morgan et al., Interference with bile salt export pumpfunction is a susceptibility factor for human liver injury in drugdevelopment, Toxicological Sciences 118(2), 485-500, 2010] Thesehepatobiliary transporters maintain liver homeostasis by regulatingintracellular exposure to endobiotic and xenobiotic chemicals. Transportsystems comprising of specific transporter proteins have beenextensively investigated. Transporters at the basolateral membrane areinvolved in hepatocellular uptake of various substrates from the bloodand sinusoids, elimination to the blood and sinusoids, or both dependingon the transporter. Transporters on the apical membrane, however, areexclusively efflux transporters, mediating secretion into the bile flowof various substrates including bile acids and salts. [Morgan et al.,id. page 485]

Bile Salts Export Pump: BSEP (all capitalized letters reflect humantransporter gene product) is a membrane-associated transporter proteinlocated on the hepatocyte apical or canalicular membrane and is a memberof the superfamily of ATP-binding cassette (ABC) transporter proteins,which are responsible for the extracellular transport or secretion ofconjugated and unconjugated bile acids and salts into the bilecanaliculi. [Kis et al., BSEP inhibition: in vitro screens to assesscholestatic potential of drugs, Toxicology In Vitro 26(8), 1294-9, 2012]BSEP is also known as ATP-binding cassette, sub-family B member 11,ABCB11, which is the protein product of the human ABCB11 gene (italicsreflect the human gene). BSEP was first cloned in 1998 from rat andidentified as the “sister of P-glycoprotein (sPGP)”, based on its closeamino acid sequence similarity to P-glycoprotein. [Kis et al., Effect ofmembrane cholesterol on BSEP/Bsep activity: species specificity studiesfor substrates and inhibitors, Drug Metabolism and Disposition 37,1878-1886, 2009, page 1878] BSEP displays higher transport affinitybinding for tauro- and glycochenodeoxycholic acid and lower fortaurocholic acid, glycocholic acid and tauroursodeoxycholic acid.[Jansen and Faber id. page 178] BSEP can transport to a limited extentunconjugated bile acids. [id.] BSEP, in addition to exporting bilesalts, can also export some xenobiotics and drugs including pravastatinand vinblastine. [Morgan et al., id. page 485]

Rat and mouse orthologs of the human BSEP have similar amino acidsequences sharing 82% and 80%, respectively. [Yabuuchi H, et al, Cloningof the dog bile salt export pump (BSEP; ABCB11) and functionalcomparison with the human and rat proteins, Biopharmaceutical DrugDisposition, 29(8), 441-8, 2008] BSEP is specialized for transportingmonovalent bile salts—taurine and glycine conjugates—through thecanalicular membrane against a concentration gradient in anATP-dependent manner. [Kis et al., id. page 1878] BSEP transport of bilesalts is a saturable process with K_(m) values for bile salts in the lowmicromolar range. [Kis id.] The sensitivity to impairment in BSEPtransport function appears to display species specificity. [Kis id.]Mutations in human BSEP can lead to progressive intrahepatic cholestasisand liver failure (see below).

Additional ABC transporters expressed at the apical and basolateralmembrane include multidrug-resistance related protein MRP2 (ABCC2),breast cancer resistance protein BCRP (ABCG2, also known as MXR) andmultidrug-resistance protein MDR1 (ABCB1, also known as P-glycoprotein).[Chandra and Brouwer, Pharmaceutical Research 21(5) 719-735, 2004]

In humans, the levels of the various transporter proteins are subject togenetic polymorphism in the encoding genes as well as in thesetranscription factors. Adverse drug reactions may be caused by geneticor disease-induced variations of transporter expression or drug-druginteractions at the level of these transporters. [Faber et al., Drugtransport proteins in the liver, Advanced Drug Delivery Reviews 55(1),107-24, 2003]

Drug-Induced Liver Injury (DILI): Drug-induced liver injury encompassesa spectrum of clinical diseases ranging from mild biochemicalabnormalities to acute liver failure. [Hussanin and Farrington,Idiosyncratic drug-induced liver injury: an overview, Expert Opinion inDrug Safety 6(6), 673-84, 2007] Most frequently, the underlyingmechanism of DILI is poorly understood. In some cases of DILI, the liverinjury is categorized as idiosyncratic—unknown etiology. [Wolf et al.,Use of cassette dosing in sandwich-cultured rat and human hepatocytes toidentify drugs that inhibit bile acid transport, Toxicology In Vitro24(1), 297-309, 2010; Lee, Drug-induced hepatotoxicity, New EnglandJournal of Medicine 349(5), 474-85, 2003] The incidence of DILI inducedhepatotoxicity in clinically marketed drugs is relatively rare, rangingfrom 1 in 5,000 to 1 in 10,000 or less. This is particularly true forDILI that results in severe liver injury leading to irreversible liverfailure that can be fatal or require liver transplantation. DILI is amajor cause of removal of approved drugs from the United States marketresulting in removal of clinically significant therapeutics frompatients in need of such therapy. [FDA Guidance for Industry:Drug-induced liver injury—premarketing clinical evaluation, July 2009;Ansede et al., An in vitro assay to assess transporter-based cholestatichepatotoxicity using sandwich-cultured rat hepatocytes. Drug Metabolismand Disposition 38, 276-280, 2010] Additional consequences of DILIinclude class action lawsuits against the innovator company (withmulti-million of dollar settlements), while adding additional time,expense, and uncertainty to the drug discovery and development process.

Because the modern drug development process requires extensivepreclinical testing of drug candidates and subsequent clinical trials,drugs that do ultimately lead to DILI are rare. Drug candidates thatdisplay a toxic potential are usually removed from development and neverreach the market. [FDA Guidance id.] Nevertheless, drugs that laterresult in DILI do get approved. Reasons for this may involve therelatively rare nature of the adverse event and that clinical trials areconducted in a closely controlled patient environment with a limitednumber of subjects for a limited time. Following marketing approval, thenumber of individuals administered a therapeutic agent will be muchgreater, periods of treatment may be much longer, and patients are lesswell monitored. Individuals display a wide variability in hepaticfunction and can differ greatly with respect to inherent hepaticmetabolic function, environmental factors and co-medications. Riskfactors for DILI include age, sex and genetic polymorphisms ofdrug-metabolizing enzymes such as cytochrome P450. In patients withhuman immunodeficiency virus, the presence of chronic viral hepatitisincreases the risk of antiretroviral therapy hepatotoxicity. [Hussainiand Farrington, id. Abstract]

The relatively low incidence rate of DILI creates difficulties indetecting and diagnosing it; both for tests used and for numbers ofpatients needed. There is no clinical finding that indicates DILI withcertainty, including liver biopsy. Because DILI may simulate any knownliver disease, the histopathologic picture frequently is reported to be“compatible with” the clinical and laboratory information available, butis not often diagnostic. Therefore, the diagnosis of DILI is one ofexclusion, in which sufficient clinical information must be gathered torule out other possible causes of the abnormal findings. This diagnosisby exclusion requires collecting considerable data at the time of theacute clinical situation, a process that frequently is not well orthoroughly done, so that available information is inadequate toestablish the likelihood of drug causality with any reasonable degree ofconfidence. [FDA Guidance. page 3-7]

In most controlled clinical trials, monitoring is done to detect hepaticinjury by serum enzyme (typically aminotransferase) activity increases.Because risks associated with the new drug are unknown, caution hasdictated that stopping rules be used to limit liver damage during thetrial. For safety reasons, the drug may be stopped before the fullimplications of its possible toxicity can be determined. Extrapolationof such data, despite early withdrawal of the drug in many cases, isused to predict the likelihood of future severe toxicity when the drugis used clinically.

For interpreting data from patients exposed to drugs in clinical trials,there is a hierarchy of findings that indicate progressively severeliver injury, beginning with serum amino-transferase activities as themost frequently abnormal and most sensitive test. [FDA Guidance id.] Inmany clinical trials of new drugs, up to 15% of study patients (or evenmore) may demonstrate mild elevations of alanine aminotransferase (ALT)or aspartate aminotransferase (AST) activities. The threshold requiredto consider either more frequent monitoring of blood levels, or stoppingthe drug, is variously placed at twice the upper limit of the normal orreference range (2×ULN), 3×ULN, or 5×ULN. Monitoring is typicallyperformed on a monthly basis but may be shortened to biweekly or weeklyif elevations in serum enzyme levels are noted. According to the FDAguidance on drug-induced liver injury:

Discontinuation of Treatment should be Considered

-   -   ALT or AST>8×ULN    -   ALT or AST>5×ULN for more than 2 weeks    -   ALT or AST>3×ULN and (TBL>2×ULN or INR>1.5)    -   ALT or AST>3×ULN with the appearance of fatigue, nausea,        vomiting, right upper quadrant pain or tenderness, fever, rash,        and/or eosinophilia (>5%)        -   TBL—Total bilirubin Levels        -   INR—Increase plasma thrombin time        -   FDA Guidance for Industry—Drug induced liver injury:            premarketing clinical evaluation, 2009, page 10

Levels of 10×ULN typically mandate immediate cessation and areconsidered more serious signals but still do not represent true tests ofliver function. Yet great difficulties persist in making accurateattribution of causality as to whether the abnormalities seen are causedby DILI or by some other disorder. [FDA Guidance, pages 3-7, 10]

Even modest increases of serum total bilirubin concentration mayrepresent the beginning of reduced bilirubin excretion capacity,provided Gilbert's syndrome and other unrelated causes of bilirubinelevation could be excluded. It is truly a function of the liver toclear plasma of bilirubin and excrete it into the bile. The late HymanZimmerman in 1978 and again in 1999 proposed that appearance of jaundiceassociated with drug-induced hepatocellular injury indicated possiblemortality in 10 to 50% of patients showing that combination ofabnormalities, based on his careful review of many clinical trials andliterature reports. [FDA Guidance page 4]

Another commonly done test, the blood prothrombin time (or itsderivative Internationalized Ratio, INR) may be useful as a liverfunction test (of protein synthesis). In acute liver failure caused byacetaminophen overdose, increases in INR may precede rises in totalbilirubin levels. Thus, only a small decrement in liver function inpre-approval trials may provide a signal that additional and more severecases may occur when larger numbers of patients are exposed. The fullimpact of this may not be realized until after approval for clinical useand marketing.

The condition of cholestasis occurs when bile and bile fluids cannotflow from the hepatocytes to the duodenum. The accumulation of bilesalts in hepatocytes can lead to cellular apoptosis, necrosis andmitochondrial dysfunction. [Wolf et al., id. page 298] Cholestasis mayresult from physical obstructions—gallstones or tumors, or frommetabolic disorders—drugs interfering with BSEP and other transporters.

BSEP inhibition and DILT: ATP-dependent transporters expressed on theapical plasma membrane domain of hepatocytes are important mediators ofcanalicular bile flow (see above). [Morgan et al., id. page 485]Impaired bile flow arising from genetically determined defects intransporters has been implicated in various inherited forms ofcholestatic liver disease in humans. Genetic defects or mutations inBSEP are associated with at least three clinical forms of liver disease:(1) progressive familial intrahepatic cholestasis type 2 (PFIC2); (2)benign recurrent intrahepatic cholestasis type 2 (BRIC2); and (3)intrahepatic cholestasis of pregnancy. [Morgan et al., id. page 486] Inthe case of PFIC2, the condition has been associated with one or morepolymorphisms in the genetic code for BSEP leading to inadequate BSEPfunction and associated liver injury. PFIC2 is characterized byprogressive liver damage usually requiring transplantation while BRIC2is characterized by intermittent and non-progressive cholestasis.

BSEP protein levels have been correlated with taurocholate transportactivity in in vitro studies showing that patients with PFIC2 and BRIC2gene mutations correlate with decreased protein expression. [Byrne etal., Missense mutations and single nucleotide polymorphisms in ABCB11impair bile salt export pump processing and function or disruptpre-messenger RNA splicing, Hepatology 49, 553-567, 2009] Studiesindicate that the extent of decrease in BSEP expression and functioncorresponds to disease outcome. [Morgan et al., id. page 486; Kagawa etal 2008]

Interference in BSEP function can lead to impaired hepatobiliarysecretion of bile acids and salts leading to increased serum and tissuelevels of bile acids and subsequent cellular mitochondrial damage,apoptosis (programmed cell death) and necrosis. [Maillette de BuyWenniger, Bile salts and cholestasis, Dig Liver Dis. 42(6) 409-18, 2010]

Knockout mice have provided further insight into the complexinterrelationships between expression of individual bile salttransporters, bile flow, and liver injury. Homozygous Bsep (mouse bilesalt transporter protein) knockout mice were shown to develop severecholestasis when fed a bile acid-enriched diet, whereas only mildcholestasis was observed when animals were fed a normal diet. Thisresult has been attributed to adaptive changes in expression of otherenzymes and transporters in Bsep (−/−) mice, which enable them to copewith the lack of functional Bsep expression unless challenged with ahigh dietary bile acid load. [Wang et al., Sever cholestasis induced bycholic acid feeding in knockout mice of sister of P-glycoprotein,Hepatology 38(6), 1489-99, 2003; Wang et al., Compensatory role ofP-glycoproteins in knockout mice lacking the bile salt export pump,Hepatology 50(3). 948-56, 2009] Additional transporters have beenimplicated in cholestatic liver injury via studies undertaken inknockout mice include Mdr2 (the rodent ortholog of human MDR3). [Fickertet al., Regurgitation of bile acids from leaky bile ducts causessclerosing cholangitis in Mdr2 (Abcb4) knockout mice, Gastroenterology127(1), 261-74, 2004]

Therapeutic agents that interfere with BSEP function are oftenassociated with liver liabilities in humans. [Morgan et al., id. page486] Examples of drugs implicated in human liver injury where BSEP hasbeen an implicated mechanism include bosentan (an endothelin antagonistfor pulmonary arterial hypertension [PAH]), erythromycin estolate (amacrolide antibiotic), nefazodone (5-HT₂ receptor antagonist fordepression), CI-1034 (an experimental endothelin antagonist forpulmonary arterial hypertension [PAH]), and CP-724,714 (an experimentalHER2 kinase inhibitor for oncology). [Morgan et al., id. page 486]

Agents that interfere with BSEP function and display liver injury inhumans often are not associated with liver injury in preclinical animalinvestigations indicative of species differences. [Stieger et al., Roleof the bile salt export pump, BSEP, in acquired forms of cholestasis,Drug Metabolism and Disposition 42, 437-445, 2009] This discrepancy inpredicting liver toxicity of preclinical animal models is a significantconcern for the pharmaceutical industry and increases the risk ofunexpected liver injury in clinical development.

BSEP Inhibition and Drug-Drug Interactions: The potential for BSEPinhibitors to inhibit drug elimination was investigated insandwich-cultured rat hepatocytes. [Jemnitz et al., Biliary effluxtransporters involved in the clearance of rosuvastatin in sandwichcultured of rat hepatocytes, Toxicology In Vitro 24(2), 605-10, 2010] Inthis study, the 3-hydroxy-3-methylglutaryl coenzyme A reductaseinhibitor rosuvastatin, which is eliminated primarily unchanged bytransporters, was used as a marker of transporter elimination. Variousknown inhibitors of elimination transporters were tested for effect onrosuvastatin elimination including the BSEP inhibitors cyclosporine A,glibenclamide and troglitazone. Results showed that cyclosporine A,glibenclamide and troglitazone interfered 32.6%, 29.3% and 20.6%,respectively, with rosuvastatin elimination. The investigators concludeda potential exists for drug-drug interactions with test agents thatinterfere with BSEP function.

BSEP Function Assays: In standard in vivo preclinical animal tests ofdrugs and drug candidates, agents found to interfere with BSEP functionoften don't induce significant liver injury; but nevertheless, have beenassociated with significant liver injury when administered to man.[Morgan et al., id. page 486] The inability of animal testing to predictthe human hepatotoxicity potential of a drug, drug candidate,biological, food component, chemical, peptide, protein, oligonucleotide,DNA and RNA has led scientists skilled in the art to develop in vitrotest model systems for BSEP function. These in vitro model systemsinclude but not limited to:

-   -   (1) Sandwich-cultured hepatocyte (SCH) model prepared using        primary animal or human hepatocytes;    -   (2) BSEP transfected Sf9 insect cell membrane vesicle models;    -   (3) Canalicular membrane vesicles (CMV) derived from rat and        human whole liver; and    -   (4) Doubly-transfected with BSEP and sodium taurocholate        co-transporting polypeptide (NTCP).

Sandwich-Cultured Hepatocyte (SCH): Human and rat SCH is an in vitromodel system that maintains many in vivo structural and functionalcharacteristics of the hepatocyte, including canalicular and basolateralmembrane domains, expression and localization of liver-specificproteins, and functional bile excretion into sealed canalicularnetworks. [Wolf et al., id. page 298] Human and rat SCH have been usedto study the inhibitory effects of drugs including troglitazone,nefazodone, and anti-retroviral agents.

Initial culturing methods employed for SCH led to realization ofproblems that diminish the ability of in vitro cultures to predict invivo responses. [US2010035293A1 paragraph 0005] For example, culturinghepatocytes in the sandwich configuration form canalicular network(s)sealed by tight junctions, analogous to closed compartments, into whichbile salts, bile acids and other components of bile are excreted. Due tothe closed nature of the canalicular compartments, substances excretedfrom hepatocytes accumulate in these compartments. Over multiple days inculture, this results in cholestatic condition, wherein in bile istrapped in the bile ducts or compartments. Due to the “back-up” of thetrapped bile salts and acids and other endogenous substances thehepatocytes may attempt to compensate by up-regulation ordown-regulation of various transport proteins. In addition metabolicpathways also may be affected by the degree of cholestasis, leading toinduction or inhibition of various enzymes including drug-metabolizingenzymes. [US2010035293A1 paragraph 0020] In an attempt to address thislimitation, a process of pulsing the SCH at various time intervals byexposing the hepatocyte culture to a calcium-free buffer that releasesthe accumulated bile from the canalicular compartments. [US2010035293A1paragraph 0021-0022] Such a method could reduce cholestasis in culturedhepatocytes and potentially be used as a model to predict the in vivometabolism of compounds of interest. [US2010035293 paragraph 007]Further, such a method could allow for the development of models toevaluate the in vivo toxicity and biliary excretion of compounds ofinterest. [id.] Since SC human hepatocytes also retain metaboliccapabilities, this model may allow for investigation of the interplaybetween many of the processes that take place in vivo. [Ghibellini etal., Methods to evaluate biliary excretion of drugs in human: an updatereview, Molecular Pharmacology 3(3), 198-211, 2006]

The pulsed SCH method assumes that regularly pulsing the in vitrohepatocyte culture will provide a system that more closely mimics invivo hepatocytes, thereby providing a system that can not only assesstransporter expression and function, but also be of use in evaluatinghepatic toxicity and cholestasis. [US2010035293 paragraphs 44-47]

Nevertheless, the pulsed approach involves a complex series of stepsinvolving using freshly isolated rat or human hepatocytes plated ongelled collagen coated 6-well plates and overlaying the cells with alayer of gelled collagen one day after plating to form thesandwich-culture configuration. [US2010035293 paragraph 51] The SCHculture is then pulsed at specific times for specific lengths withHank's balanced salt solution (HBSS) with calcium (HBSS+Ca) orcalcium-free HBSS (HBSS−Ca) followed by removal of the buffer. Thefrequency and length of pulsing can be important—incubation of HBSS−Cafor 30 minutes once per day or incubation of HBSS−Ca for 15 minutestwice per day. [US2010035293 paragraph 51] Clearly, the system iscomplex, has been developed with freshly prepared hepatocytes, andrequires a high level of expertise to practice, and the requirement forfrequent pulsing creates problems for contamination by microbes. Thepotential for differences in transport function between rat and humanSCH in response to pulsing was not addressed. [Wolf et al., id. page308]

Another issue with the SCH model is the limited number of sample wellsavailable for experiments. In an attempt to address this problem, amodified method using an approach of cassette testing, incubations ofmultiple test agents in the same sample well, was described. [Wolf et alid.] The use of cassette testing of drug candidates, two to four drugcandidates per incubation well, can lead to complex results—falsepositives and negatives, requiring follow-up testing of individualagents. The method has similar issues as described above along with arequirement for radiolabeled bile acids to measure transport activity.Because of the limited availability of fresh human hepatocytes andpotential species differences with rat hepatocytes, the method islimited for any routine test agent-screening paradigm.

BSEP Transfected Sf9 Insect Cell Membrane Vesicles: The Sf9 system iswidely used expression system for investigations of plasma membraneproteins properties. Because of its ability to express in significantamounts various membrane proteins, the system has been adapted to usewith ABC transporters including human BSEP and various animal speciesBsep. [Kis et al., id. page 1879; U.S. Pat. No. 8,129,197 column 2 lines38-45]. Assay systems based on insect cell membrane preparations aregenerally stable, reliable, easy to handle and several assay formats areoffered. [U.S. Pat. No. 8,129,197 id.] Nevertheless, insect cellmembrane preparation assays differ when compared to mammalian cell basedassays, which questions their value as useful and relevant assay systemsfor drug development. [U.S. Pat. No. 8,129,197 column 2 lines 46-50]Differences include high basal ATPase activity making transport assaysless sensitive. [U.S. Pat. No. 8,129,197 column 2 lines 51-54]Differences between insect and mammalian membrane preparations have beenobserved in the activity of transporters and their sensitivity for drugsincluding sulfasalazine, topotecan, prazosin and methotrexate. [U.S.Pat. No. 8,129,197 column 2 lines 63-67] Some of these differences maybe due to improper protein glycosylation and low Sf9 membranecholesterol content. [Kis et al. id. page 1883]

In an attempt to address this issue, Kis et al., added cholesterol tothe BSEP/Bsep Sf9 transfected cell cultures to load the preparedmembrane vesicles with additional cholesterol. [Kis et al., id. page1879] The optimized treatment increased the cholesterol 3- to 4-foldcompared to untreated membrane vesicles. Inside-out vesicles areincubated at 37° C. for 5 min using 50 μg protein/well in the presenceof 4 mM ATP and 2-μM total glycocholate (including ¹⁴C-glycocholate).The reaction is stopped by addition of ice-cold wash buffer withconsecutive rapid filtration through Millipore Corporation (Billerica,Mass.) B-glass fiber filters of a 96-well filter plate. After washingfive times with 200 μL of ice-cold wash buffer, the filters are dried,and the retained radioactivity measured in scintillation mixture.Species comparison of cholesterol loading showed the most pronouncedeffect on rat protein, whereas the activity of human BSEP was leastaffected by the treatment. [Kis et al., id. page 1881] In the assay,troglitazone and glibenclamide, compounds known to be cholestatic inhumans, displayed species-specific inhibitory profiles. Results showthat cholesterol loading makes BSEP/Bsep work more efficiently (higherV_(max)), while not apparently changing the affinity (K_(m)) for thetransporter for most substrates tested. Nevertheless complexity ofpreparing the inside-out membrane vesicles and the differences betweenhepatocyte membranes and insects limits the utility of this method forpredicting test agent inhibition potential. In addition, the method hasissues of sensitivity, ease of use and requirement of radiolabeled bilesalts.

A modified version of this method involving a taurochenodeoxycholate(TCDC) ATPase activity has been designed to be more user friendly,sensitive, and minus the radiolabeled bile salts. [Kis et al., MouseBsep ATPase assay: a nonradioactive tool for assessment of thecholestatic potential of drugs, Journal Biomolecular Screen 14(1),10-15, 2009 (Abstract)] Comparison of TCDC transport measured by avesicle transport assay and the TCDC-stimulated ATPase assay usingcholesterol loaded transfected Sf9 insect inside-out vesicles showedATPase assay to be sensitive for detection of transport function. A goodrank order correlation was found between IC₅₀ values measured inTCDC-stimulated mouse Bsep ATPase assay and in the human BSEP vesiculartransport assay utilizing taurocholate (TC) as probe substrate. Themethod may complement the human BSEP-mediated taurocholate vesiculartransport inhibition assay.

Saito et al 2009 describes many issues in preparing Sf9 inverted(inside-out) membrane vesicles including the timing of harvesting of Sf9cells after baculovirus infection. [Saito et al., Technical pitfalls andimprovements for high-speed screening and QSAR BSEP, The AAPS Journal,11(3), 581-589, 2009, page 582] The study further highlights theimportance of maintaining high integrity of the membrane vesicles usedin transport assays.

In summary, the assay suffers from issues of transporter activity inmembranes between insect and human/animal hepatocytes, complexity inpreparing the transfected insect inside-out vesicles, the use ofradiolabeled bile salts, and the inability to assess indirect affects(i.e. metabolism) of test agents on transport. Further, the assay doesnot allow for measuring formation of bile salts and test agent derivedmetabolites.

Canalicular Membrane Vesicles (CMV): The CMV has been used a model tostudy Bsep-mediated interactions isolated from humans and animalsbecause this system contains all the relevant canalicular transportersat an expression level close to physiological. However, speciesspecificity studies using CMVs from humans are difficult because oflimited access to human samples and the complexity of dealing withpolymorphisms. [Ghibellini et al., id. page 205; Kis et al., id. page1883; Horikawa et al., Potential cholestatic activity of varioustherapeutic agents assessed by bile canalicular membrane vesiclesisolated from rats and humans, Drug Metabolism and Pharmacokinetics 18,16-22, 2003] Nevertheless, CMVs prepared from primary hepatocytes havedistinct advantages over transfected systems: the native membraneenvironment is in place during isolation from the other cellularcomponents, and all the hepatic transport systems are present. Membranevesicles can be prepared, stored frozen, and used as needed; however,isolation of basolateral and canalicular fractions is labor intensiveand complete purity is never achieved. [Ghibellini et al. id. page 205]

The CMV method was used to evaluate the potential of 15 therapeuticagents, known to cause cholestasis, to inhibit BSEP transports. Thestudy was conducted using rat CMV. These results suggest that themajority of cholestasis-inducing drugs have a minimal inhibitory effecton rat BSEP and MRP2 although species differences in inhibitorypotential should be considered, especially in the case of BSEP.[Horikawa et al. id.]

Doubly-Transfected Cell lines: A cell-based assay system in which aliver uptake transporter (human sodium taurocholate co-transportingpolypeptide [NTCP]) is constitutively expressed together with a liverexport pump (ABC transporter—human BSEP) in the polarized canine kidneycell line MDCKII. [US2007/0287167 paragraph 0007] The resulting dogkidney cell line, therefore, contains human NTCP together with humanBSEP. The cells are cultivated in 6-well filter inserts on a porousfilter membrane that separates the basolateral membrane domain from theapical membrane domain. Test compounds are added to either the apicaldomain compartment or basolateral domain compartment for transcellular(vectorial) transport measurements in both directions. Samples are takenfrom each compartment at designated time periods. Substrates of thecombination expressed transporters display significant net transportfrom basolateral to the apical compartment when compared toun-transfected cell. This method can be used to assess the test compoundpotential to participate in hepatobiliary elimination. The method canalso be used to investigate drug-drug interaction potential between twotest compounds. [id., paragraph 0010] Nevertheless, the system differssignificantly from that of human hepatocytes.

Rationale for the Invention

A continued need exists for an in vitro method that can more reliably,routinely and accurately be used to study in vivo hepatobiliaryprocesses including bile salt export transport and/or formationactivity. The method should be adaptable and scalable to modern drugdiscovery screening paradigms. The method should be flexible to allowinvestigation of test agent-derived metabolites on bile salt exporttransport and/or formation. The presently disclosed subject matteroffers the ability to assess test agent effect on bile salt exporttransport and/or formation. Furthermore, the method offers potential todecrease the use of animals in preclinical drug development. Finally,the results from the present method can be used to predict test agentpotential for drug-induced liver injury, cholestasis, drug-druginteractions.

BRIEF DESCRIPTION OF THE INVENTION

A method is presently disclosed to measure modulation of bile saltexport transport and/or formation activity in hepatocyte or stable cellline preparations by test agents including but not limited to drugs,drug candidates, biologicals, food components, herb or plant components,proteins, peptides, DNA, RNA. Furthermore, the method is to determinemodulation of bile salt export transport and/or formation activity notonly by said drugs, drug candidates, biologicals, food components, herbor plant components, proteins, peptides, oligonucleotides, DNA, and RNA,but further their metabolites or biotransformed products formed in situ.The bile salt export transport and/or formation activity modulationincludes but is not limited to inhibition, induction, activation and/orregulation.

More specifically, an in vitro method is provided using hepatocytepreparations from human and animal livers or stable cell lines such asHepG2 that are incubated with a bile salt precursor compound(s) and atest agent to determine the test agent's effect on inhibition,induction, activation and regulation of bile salt export transportand/or formation. The hepatocyte preparations include suspensions ofhepatocyte in an incubation buffer or hepatocytes plated on a suitablemedium or support. Stable cells lines such as HepG2 can be suspended ina suitable incubation buffer or plated on a suitable medium or support.The source of hepatocytes can be from freshly prepared human or animallivers or can be cryopreserved hepatocytes prepared from human or animallivers.

The bile salt precursor compounds include but are not limited to cholicacid, chenodeoxycholic acid, deoxycholic acid and lithocholic acid. Thebile salt precursor compounds further include all natural bile acids andtheir derivatives, which can be made by chemical and biological means.The bile salts or conjugated bile acids include but are not limited toglycocholic acid, taurocholic acid, glycodeoxycholic acid,taurodeoxycholic acid, glycolithocholic acid, taurolithocholic acid,glycochenodeoxycholic acid and taurochenodeoxycholic acid. The bilesalts or conjugated bile acids include all natural bile salts and theirderivatives, which can be made by chemical and biological means.

Furthermore, the present subject matter describes procedures, incubationconditions and cell culture components to maintain and monitor bile saltexport transport and/or formation in hepatocyte preparations, and themeans to determine the concentrations of bile salts. These include butare not limited to the concentration of hepatocytes, the incubationtime, the concentrations of bile salt precursor compounds, the means toseparate extracellular and intracellular portions of bile salts, theprocedures to prepare the cells and to perform the incubations. Themeans to determine the concentrations of bile salts include but are notlimited to HPLC, mass spectrometry (MS), liquid chromatography massspectrometry, radioactive counting, and fluorescence.

Even furthermore, the present subject matter describes a method that canbe used with stable cell preparations derived from HepG2 cell lines thatare incubated with a bile salt precursor compound and test agent tomeasure a test agents effect on bile salt export transportand/formation.

This method is readily adaptable to a variety of high throughputscreening approaches where hepatocyte preparations or stable cell linescan be used in incubations with bile salt precursor compounds and testagents and post-incubation measurements of bile salt extracellularand/or intracellular concentrations are determined.

An advantage of the present subject matter is the ability to assess testagents ability to inhibit, induce, activate, and/or regulate bile saltexport transport and/or formation without using radioactive materials.Furthermore, the method can be adapted to a variety of incubationpreparations including hepatocyte suspension and plating as well asstable cell line such as HepG2 suspensions or plating. The method is notlimited to any specific incubation formats such as the size and numberof incubation chambers.

Furthermore, the present subject matter can be provided in the form ofkit comprising buffers, reagents, chemicals, bile salt precursorcompounds, bile salts, internal standard, incubation platforms, anddirections that allows a person skilled in the art to practice thepresent invention.

Even furthermore, the method allows for the ability to assessmetabolites derived from test agents for their potential to inhibit,induce, activate, and/or regulate bile salt export transport and/orformation.

Finally, the presently disclosed method and kit can be used to identifychemicals or biologics which have potential to cause liver injury,drug-drug interactions, and/or could be used as therapeutic agents forthe treatment of cholestasis, abnormality of bile salt metabolism, liverdiseases and cholesterol abnormality.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1: Chemical structures of bile acids (bile salt precursorcompounds) and bile salts (conjugate bile acids).

FIG. 2: Bile acid metabolic pathway starting from cholesterol metabolismin the liver hepatocyte whereby cholesterol undergoes oxidativemetabolism either by the cytochrome P450 CYP7A1 or cytochromes P450CYP27A1/BYP7B1 to intermediates. The intermediates are furtheroxidatively metabolized to cholic acid and chenodeoxycholic acid,respectively, and conjugated with the amino acids glycine (G) or taurine(T) to form conjugated bile acids or bile salts that are excreted fromthe hepatocyte into the bile duct by the membrane transporter proteinBile Salt Export Pump (BSEP). From the bile duct, the formed bile saltsare secreted into the intestine.

FIG. 3: Effect of hepatocyte concentration or density on the transportand formation of bile salts in human hepatocytes. Upper panel: humanhepatocytes (0.25 million cells/mL) were incubated with cholic acid (CA,100 μM) for 1 hour and the transport and formation of glycocholate (GCA,left) or taurocholate (TCA, right) determined; lower panel: humanhepatocytes (0.25 million cells/mL) were incubated with chenodeoxycholicacid (CDCA, 100 μM) and the transport and formation ofglycochenodeoxycholate (GCDCA, left) and taurochenodeoxycholate (TCDCA,right) determined.

FIG. 4: Effect of incubation time on the transport and formation of bilesalts in human hepatocytes. Upper panel: human hepatocytes (0.25 millioncells/ml) were incubated with cholic acid (CA, 100 μM) for various timesand the transport and formation of glycocholate (GCA, left) ortaurocholate (TCA, right) determined; lower panel: human hepatocytes(0.25 million cells/mL) were incubated with chenodeoxycholic acid (CDCA,100 μM) for various times and the transport and formation ofglycochenodeoxycholate (GCDCA, left) and taurochenodeoxycholate (TCDCA,right) determined.

FIG. 5: Effect of cholic acid and chenodeoxycholic acid concentration onthe transport and formation of bile salts in human hepatocytes. Upperpanel: human hepatocytes (0.25 million cells/ml) were incubated withcholic acid (CA) for 1 hour and the transport and formation ofglycocholate (GCA, left) and taurocholate (TCA, right) determined; lowerpanel: human hepatocytes (0.25 million cells/mL) were incubated withchenodeoxycholic acid (CDCA) for 1 hour and the transport and formationof glycochenodeoxycholate (GCDCA, left) and taurochenodeoxycholic acid(TCDCA, right) determined.

FIG. 6a : The percent inhibition of BSEP (bile salt export transport)activity in mouse, rat, dog, monkey, and human hepatocyte preparationswhen incubated with various concentrations of the test agenttroglitazone, a known inhibitor of BSEP. Incubations were conductedusing either 10-μM cholic acid or chenodeoxycholic acid at 37° C. for 1hour.

FIG. 6b : The percent inhibition of BSEP (bile salt export transport)activity in mouse, rat, dog, monkey, and human hepatocyte preparationswhen incubated with various concentrations of the test agent ritonavir,a known inhibitor of BSEP. Incubations were conducted using either 10-μMcholic acid or chenodeoxycholic acid at 37° C. for 1 hour.

DETAILED DESCRIPTION OF THE INVENTION

In relation to the presently disclosed subject matter, a novel method isprovided for measuring a test agents ability to modulate bile saltexport transport and/or formation activity in preparations of human andanimal hepatocytes or in stable hepatic derived cell lines such as HepG2by incubation of a bile salt precursor compound or compounds and thesaid test agent in said preparations followed by measuring extracellularand intracellular bile salt concentrations post-incubation. The testagents used in the present invention include but are not limited todrugs, drug candidates, biologicals, food components, herb or plantcomponents, proteins, peptides, oligonucleotides, DNA and RNA.Interference with bile salt export transport and/or formation isassociated with drug-drug interactions and drug-induced liver injury.The bile salt export transport and/or formation activity modulationincludes but is not limited to inhibition, induction, activation and/orregulation. Furthermore, the method allows for a test agent-derivedmetabolite(s) to be tested for modulation of bile salt export transportand/or formation activity. The present invention can be provided in theform of kit comprising buffers, reagents, chemicals, bile salt precursorcompounds, bile salts, internal standard, incubation platforms, paperand/or electronic directions and additional materials necessary to allowa person skilled in the art to practice the present invention.

Furthermore, the presently disclosed invention to measure a test agent'sability to modulate bile salt export transport and/or formation can beused by a person skilled in the art as a drug discovery screen fortesting said agent's potential to cause liver injury, drug-druginteractions, and/or potential as a therapeutic for purposes of treatinga condition such as cholestasis, abnormality of bile salt metabolism,liver diseases and cholesterol abnormality. Even further, the presentinvention can be used as part of a drug discovery-screening paradigm.

Hepatocytes have specific membrane domains, that one skilled in the artwould recognize including but not limited to an apical (canalicular)membrane or domain and a basolateral (blood or sinusoidal domain)membrane or domain. The hepatocyte basolateral membrane or domain isinvolved in the uptake into the cell of drugs and xenobiotics, while theapical membrane or domain provides a route for intracellular producedbile salts to be excreted or transported out of the cell into the bileflow. [Morgan et al., id. page 485] Transport of bile salts out ofhepatocytes into bile primarily involves transporter proteins located onthe cells apical membrane. [Morgan et al., id.]

ATP-binding cassette (ABC) transporters constitute one of the largestfamilies of membrane transport proteins and can transport a wide rangeof different substrates ranging from small ions to large proteins acrossbiological membranes using ATP as an energy source. [Ellinger et al.,Detergent screening and purification of the human liver ABC transportersBSEP (ABCB11) and MDR3 (ABCB4) expressed in the yeast Pichia pastoris,PLOS One 8(4), 1-12, 2013, page 1] In hepatocytes, eleven ABCtransporters are expressed including three ABC transporters involved inbile formation—BSEP (ABCB11), MDR3 (ABCB4) and ABCG5/8. [Ellinger etal., id. page 1]

One of the transporters in the apical or canalicular domain ofhepatocytes is the transporter protein named bile salt export pump.[Morgan et al. id. page 485] Bile salt export pump is abbreviated asBSEP in the case of the human protein and Bsep in the case of the animalprotein while the corresponding gene for the human protein is labeledBSEP and the animal Bsep. BSEP was formerly known as sister ofpermeability-glycoprotein or s-PGP based on its close amino acidsequence similarity to P-glycoprotein. [Kis et al., id. page 1878] BSEPis responsible for the elimination of monovalent conjugated bile saltsinto the bile canaliculi. The bile salt export pump is the main bilesalt transporter in human hepatocytes. [Ellinger et al., id. page 1]

Interference in BSEP function can lead to impaired hepatobiliarysecretion of bile salts producing an increase in serum and tissue levelsof bile salts that can result in cellular mitochondrial damage,apoptosis (programmed cell death) and necrosis. [de Buy Wenniger et al.,id.] Genetic defects or mutations in BSEP that interfere withhepatobiliary secretion of bile salts are associated with at least threeclinical forms of liver disease: (1) progressive familial intrahepaticcholestasis type 2 (PFIC2); (2) benign recurrent intrahepaticcholestasis type 2 (BRIC2); and (3) intrahepatic cholestasis ofpregnancy. [Morgan et al., id. page 486] In the case of PFIC2, thecondition has been associated with one or more polymorphisms in thegenetic code for BSEP leading to inadequate BSEP function and associatedliver injury. PFIC2 is characterized by progressive liver damage usuallyrequiring transplantation while BRIC2 is characterized by intermittentand non-progressive cholestasis.

BSEP protein levels have been correlated with taurocholate transportactivity in in vitro studies showing that patients with PFIC2 and BRIC2gene mutations correlate with decreased protein expression. [Byme etal., id.] Studies indicate that the extent of the decrease in BSEPexpression and function corresponds to disease outcome. [Morgan et al.,id. page 486; Kagawa et al 2008]

In the presently disclosed subject matter, bile salt export transport isused as a marker for BSEP and/or any additional bile salt transportersinvolved in the excretion from hepatocytes of bile salts.

Therapeutic agents that interfere with BSEP function have also beenassociated with liver injury and cholestasis in humans. [Morgan et al.,id. page 486] Examples of drugs implicated include bosentan (anendothelin antagonist for pulmonary arterial hypertension [PAH]),erythromycin estolate (a macrolide antibiotic), nefazodone (5-HT₂receptor antagonist for depression), CI-1034 (an experimental endothelinantagonist for pulmonary arterial hypertension [PAH]), and CP-724,714(an experimental HER2 kinase inhibitor for oncology). [Morgan et al.,id. page 486]

The potential for drugs that inhibit BSEP function to lead to drug-druginteractions was investigated using a rat sandwich-culture model of bilesalt export elimination. [Jemnitz et al., id.] In this study, the3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor rosuvastatin,which is eliminated primarily unchanged by transporters, was used as amarker of transporter elimination. Various known inhibitors ofelimination transporters were tested for effect on rosuvastatinelimination including the BSEP inhibitors cyclosporine A, glibenclamideand troglitazone. Results showed that cyclosporine A, glibenclamide andtroglitazone interfered 32.6%, 29.3% and 20.6%, respectively, withrosuvastatin elimination. The investigators concluded that a potentialexists for drug-drug interactions with test agents that interfere withBSEP function.

In modern drug discovery and development, assessing the potential for adrug candidate to produce clinical drug-induced liver injury (DILI) anddrug-drug interactions is a major issue. Several drugs have reachedmarketing approval in the United States by the Food and DrugAdministration and have later been found to produce unexpected DILI. Theextremely low rate of DILI, in some cases at rates estimated to be about1 in 10,000, have limited the utility of clinical trials, with patientpopulations in hundreds to low thousands, to predict this adversereaction. Preclinical animal models and toxicity studies often don'tshow any evidence of DILI. Therefore, drug discovery and developmentscientists have tried to develop in vitro models to predict a potentialfor DILI. Most of these methods focus on formation of reactivemetabolites, drug effects on hepatic mitochondrial function andpotential for drug-induced apoptosis (programmed cell deaths). Thesemethods are highly complex and difficult to interpret, which limitstheir utility as a drug discovery screening approach.

More recently, a greater appreciation has been realized for DILI beingthe result of interference with bile salt elimination. As mentionedabove, it has now been found that several drugs known to cause DILI havebeen found to interfere with bile salt transport out of hepatocytes.DILI toxicities include cellular mitochondrial damage, apoptosis(programmed cell death) and necrosis. The result of the toxicity can becholestasis, a condition where bile cannot flow from the liver to theduodenum. The ultimate result of DILI can be the need for livertransplantation.

The need for model systems and methods to assess the ability of drugsand test agents to interfere with bile salt export transporters has ledto the development of several in vitro approaches including: (1)sandwich-culture hepatocytes (SCH); (2) BSEP transfected Sf9 insect cellmembrane vesicle models; (3) canalicular membrane vesicles (CMV) derivedfrom rat and human whole liver, and (4) doubly-transfected with BSEP andsodium taurocholate co-transporting polypeptide (NTCP). As describeabove, each of these methods suffers from issues including reliability,difficulty in preparation of test systems, ability to incorporate indrug discovery paradigms, false positives and negatives, andextrapolation to human hepatic function.

Therefore, there exists a need to develop a method that can be used byone skilled in the art to accurately and reliably measure a test agent'sability to modulate bile salt export transport and/or formation.Furthermore, the method should be flexible to allow for studies of avariety of test agents and should offer the potential to assess theability of test agent-derived metabolites to modulate bile salt exporttransport and/or formation. Even furthermore, the method should bereadily adaptable for several different hepatocyte incubationpreparations including human and animal. The method should offer thepotential to be used with stable cell lines such as HepG2. The methodshould minimize or not require the use of radiolabeled chemicals tomeasure bile salt transport and/or formation. Even further, the methodshould be adaptable to drug discovery screens and utilize incubationplatforms that allow a test agent to be screened at appropriateconcentrations and incubation periods.

The present disclosed subject matter provides for a method to measuremodulation of transport and formation of bile salts produced inhepatocyte preparations comprising incubation of a bile salt precursorcompound with or without a test agent in said hepatocyte preparations.Post incubation concentrations of formed bile salts present inextracellular and intracellular media are measured and used to assesstest agent modulation of bile salt export transport and/or formationactivity.

Test agents include but are not limited to drug, drug candidate, foodcomponent, herb or plant component, amino acid, peptide, protein,oligonucleotide, DNA and RNA. A person skilled in the art would realizethat the test agent could be added to the incubation medium in anappropriate solvent or buffer.

Bile acid precursor compounds used in the method include but are notlimited to cholic acid, chenodeoxycholic acid, deoxycholic acid andlithocholic acid individually or in combinations. The bile saltprecursor compound is non-radiolabeled in most cases; however,radiolabeled or stable isotope labeled bile salt precursor compoundscould be used in the incubation.

Bile salts or conjugated bile acids measured following incubationsinclude but are not limited to glycocholic acid, taurocholic acid,glycodeoxycholic acid, taurodeoxycholic acid, glycolithocholic acid,taurolithocholic acid, glycochenodeoxycholic acid andtaurochenodeoxycholic acid.

The bile salt export transport and/or formation activity can beinhibition, induction, activation, or regulation. Inhibition refers to adecrease in bile salt transport and/or formation and can be competitive,non-competitive, un-competitive or irreversible. Induction refers to anincrease in hepatic proteins responsible for bile salt transport orformation of bile salts. Activation refers to the process whereby thetest agent would increase the functional activity of the proteinsinvolved in transport and/or formation. Regulation refers to controllingthe rates of bile salt transport and/or formation.

Incubations can be conducted using freshly prepared hepatocytes orcryopreserved hepatocytes obtained by standard methods from human andanimal livers that one skilled in the art would be well aware of andable to use. The hepatocytes can be used in the form of suspensions orplated on a suitable culture plate containing appropriate growth medium.

In place of hepatocytes, a person skilled in the art could use a stablecell line such as HepG2. HepG2 is a perpetual cell line derived from theliver of a 15-year-old Caucasian male with a well-differentiatedhepatocellular carcinoma. Because of the high degree of morphologicaland functional differentiation in vitro, HepG2 cells can be a suitablemodel to study the intracellular trafficking and dynamics of bilecanalicular and sinusoidal membrane proteins and lipids in humanhepatocytes in vitro. [Ihrke et al., WIF-B cells: an in vitro model forstudies of hepatocyte polarity. Journal of Cell Biology 123 (6),1761-1775, 1993]

Presently disclosed is a novel method and embodiments for measuring themodulation of bile salt export transport and/or formation activity by atest agent whereby incubations of hepatocytes from mouse, rat, dog,monkey and human are carried out at concentrations ranging from about0.001 to about 1.0 million cells/mL and can be conducted in 96-wellplates with about 0 μM to about 1000 μM cholic acid or chenodeoxycholicacid in William E buffer in the presence or absence of test agents atconcentrations ranging from about 0 μM to about 1000 μM at 37° C. under5% CO₂ for 0 to 4 hours. After incubation, the 96-well plate iscentrifuged at 2000 RPM for 15 minutes at room temperature. Thesupernatant is removed from the cell pellet and labeled as extracellularmedia.

The hepatocyte cell pellet is re-suspended in William E buffer andsubjected to a standard freeze-thaw procedure and sonication to lysecell membranes. Separately, the 2000 RPM supernatant (extracellularmedia) and the cell lysate (intracellular media) are mixed with 3 timesthe volume acetonitrile, and the resultant mixtures are centrifuged at4000 RPM for 20 minutes at 4° C. An internal standard suitable forliquid chromatography-mass spectrometry measurements of bile salts, suchas carbutamide, is added to the acetonitrile diluted supernatants.

Measurement of bile salts in the extracellular media and/orintracellular media can be accomplished by using standard liquidchromatography-mass spectrometry with multiple reaction monitoring ofspecific ions associated with glycocholic acid (GCA),glycochenodeoxycholic acid (GDCA), taurocholic acid (TCA) and/ortaurochenodeoxycholic acid (TCDCA). Quantitation of bile salts inintracellular and extracellular media is performed using standard curvesprepared from reference bile salts.

Following quantitation of selected bile salts in the extracellular andintracellular media, calculations are made for bile salt exporttransport and/or formation activity. In the case of bile salt exporttransport activity, the concentration of the measured bile salt in theextracellular media is divided by the hepatocyte cell concentration andthe length of incubation. This relates to the amount of bile saltexported into the extracellular media during the course of incubation.The selection of bile salt to measure is based on the bile saltprecursor compound used in the incubation.

Bile salt formation activity is calculated by first determining thetotal bile salts formed in the incubation. This is determined by addingthe amount of bile salts in the extracellular media with the amount inthe intracellular media. The total bile salt amount is than divided bythe hepatocyte cell concentration and the length of incubation.

The effect of a test agent in terms of percentage (%) inhibition on bilesalt export transport and/or formation activity is determined by thefollowing equation:

${\% \mspace{11mu} {Inhibition}} = \frac{( {{{Activity}\mspace{14mu} {without}\mspace{14mu} {Test}\mspace{14mu} {Agent}} - {{activity}\mspace{14mu} {with}\mspace{14mu} {test}\mspace{14mu} {agent}}} ) \times 100}{( {{Activity}\mspace{14mu} {without}\mspace{14mu} {Test}\mspace{14mu} {Agent}} )}$

In one embodiment of the disclosed subject matter, incubations ofhepatocytes from mouse, rat, dog, monkey and human are carried out atconcentrations ranging from about 0.001 to about 0.25 million cells/mLand can be conducted in 96-well plates with about 0 μM to about 1000 μMcholic acid or chenodeoxycholic acid in William E buffer in the presenceor absence of test agents at concentrations ranging from about 0.01 μMto about 1000 μM at 37° C. under 5% CO₂ for about 0 to 4 hours.

In yet another embodiment of the disclosed subject matter, incubationsof hepatocytes from mouse, rat, dog, monkey and human at concentrationsranging from about 0.001 to about 0.25 million cells/mL can be conductedin 96-well plates with about 0 μM to about 100 μM cholic acid orchenodeoxycholic acid in William E buffer in the presence or absence oftest agents at concentrations ranging from about 0.01 μM to about 1000μM at 37° C. under 5% CO₂ for about 1 hour.

In even yet another embodiment of the disclosed subject matter,incubations of hepatocytes derived from human and animal liver atconcentrations ranging from about 0.001 to about 0.25 million cells/mLcan be conducted in 96-well plates with about 10 μM cholic acid orchenodeoxycholic acid in William E buffer in the presence or absence oftest agents at concentrations ranging from about 0.01 μM to about 1000μM at 37° C. under 5% CO₂ for about 1 hour.

In another embodiment of the method, one skilled in the art wouldappreciate, that the investigator can practice the method withhepatocytes prepared from human and animal livers derived fromwarm-blooded mammals including mouse, rat, dog, rabbit, and monkey.Hepatocytes can be prepared from individual livers or as a pooled sampleof hepatocytes derived from multiple different human or animal livers.

In another embodiment, a person skilled in the art would recognize thatthe method is not limited to 96-well plates but can readily be modifiedfor use with a variety of incubation platforms including a petri dishwith cells plated in a monolayer, a single or multi-well plate formats.

In yet another embodiment, one skilled in the art would readilyrecognize that bile salts formed in the present method can be separatedfrom the extracellular and intracellular media by a variety oftechniques including but not limited to solid phase extraction with C18,C8, or anion exchange solid support, or by liquid liquid extraction, oraddition of acetonitrile, methanol, or any suitable solvent followed bycentrifugation or filtration.

A person skilled in the art would recognize that additional methods forquantitation of bile salts are available to the investigator thatinclude but are not limited to HPLC, mass spectrometry, radioactivitycounting, enzyme assay, and/or fluorescence.

An additional embodiment of the presently disclosed method can bepracticed to investigate a test agent's effect on ADME relatedprocesses. As one skilled in the art would readily recognize, the methodcan be used to allow for the measurement of test agent-derivedmetabolites to inhibit, induce, activate, and/or regulate bile saltexport transport and/or formation. In yet another embodiment of themethod, it can be modified whereby selective drug metabolizing enzymeinhibitors can be co-incubated with test agents to measure effect onbile salt export transport and/or formation. In another embodiment, oneskilled in the art would appreciate, the method can be practiced toallow for measurement of interactions between a test agent and knownmodulators of bile salt export transport and/or formation.

In another embodiment, the method can be used with human and/or animalhepatocytes that have ADME enzyme phenotypes that can allow formeasuring the effect of specific hepatic phenotype on a test agent'smodulation of bile salt export transport and/or formation. For example,hepatocytes derived from a human liver expressing a genetic polymorphismdeficiency in cytochrome P450 2D6 enzyme activity can be used in themethod to measure a test agent's modulation on bile salt exporttransport and/or formation.

As one skilled in the art would appreciate, the present method can beused as a drug discovery-screening assay to measure multiple testagents' effect on bile salt export transport and formation activity. Theassays can include known inhibitors and non-inhibitors of bile saltexport transport. Results from the screening assay can be used forselection or ranking of test agents modulation of bile salt exporttransport and/or formation. Furthermore, the method can be practiced todetermine in vitro IC₅₀ values for test agents. Additionally, theresults can be used as part of an in vitro-in vivo correlation of bilesalt export transport activity profile.

The presently disclosed subject matter for the method to measure a testagent's modulation of bile salt export transport and/or formationactivity and embodiments can be practiced to identify chemicals orbiological test agents which have potential to cause liver injury,drug-drug interactions, and/or can be used as therapeutic agents for thetreatment of cholestasis, abnormality of bile salt metabolism, liverdiseases and cholesterol abnormality.

The presently disclosed subject matter and embodiments can be providedin the form of kits comprising buffers, reagents, chemicals, bile saltprecursor compounds, bile salts, internal standard, incubationplatforms, and directions that allows a person skilled in the art topractice the instant disclosure.

The references cited in the specification are incorporated herein byreference to the extent that they supplement, explain, provide abackground for or teach methodology, techniques and/or compositionsemployed herein. The following examples have been included to illustraterepresentative modes of the invention. In light of the presentdisclosure, one of ordinary skill in the art will appreciate that thefollowing examples are intended to be representative only and thatnumerous changes, modifications and alterations can be employed withoutdeparting from the spirit of the invention.

Abbreviations: ADME: absorption, distribution, metabolism and excretion;BRIC2; benign recurrent intrahepatic cholestasis type 2; BSEP: bile saltexport pump; CMV: canalicular membrane vesicles; CA: cholic acid; CD:chenodeoxycholic acid; DCA: deoxycholic acid; DILI: drug induced liverinjury; DNA: deoxyribonucleic acid; GCA: glycocholic acid orglycocholate; GDCA: glycodeoxycholic acid or glycodeoxycholate; GCDCA:glycochenodeoxycholic acid or glycochenodeoxycholate; GLCA:glycolithocholic acid or glycolithocholate; HPLC: high performanceliquid chromatography; LC/MS/MS: liquid chromatography coupled with atandam mass spectrometry; LA: lithocholic acid; MDR1: multidrugresistance protein 1; MRM: multiple ion monitoring; PFIC2: progressivefamilial intrahepatic cholestasis type 2; RNA: ribonucleic acid; SCH:sandwich-culture hepatocytes; s-Pgp: sister P-glycoprotein; NTCP: sodiumtaurocholate co-transporting polypeptide; Sf9: Spodoptera frugiperdaovarian cells; TCA: taurocholic acid; TCDCA: taurochenodeoxycholic acid;TDCA: taurodeoxycholic acid; TLCA: taurolithocholic acid.

EXAMPLES

The following examples have been included to illustrate therepresentative modes of the invention. One of ordinary skill in the artwill appreciate that the following examples are intended to berepresentative only and that additional variations and modifications canbe employed without departing from the spirit and scope of the presentlydisclosed subject matter.

Experimental Procedures

Unless specifically stated otherwise, the following experimentalprocedures were applied.

Chemicals and Biochemicals: Cholic acid, chenodeoxycholic acid,deoxycholic acid, lithocholic acid, glycocholate, taurocholate,glycodeoxycholate, taurodeoxycholate, glycolithocholate,taurolithocholate, glycochenodeoxycholate and taurochenodeoxycholatewere purchased from Sigma-Aldrich (St Louis, Mo., USA). Mouse, rat, dog,monkey and human hepatocytes and InVitroGRO HT medium were obtained fromCelsis IVT. Williams Medium E was purchased from GIBCO. Other reagentswere purchased from Sigma-Aldrich unless stated otherwise in the text.

Preparation of hepatocytes: Functional hepatocytes to be employed in anyvariation of the present bile salt export transport and/or formationactivity assay can, as one skilled in the art would be well aware of, bederived from cryopreserved hepatocytes (stored at about −78° C.) orfreshly prepared from liver and may be co-cultured with other cell typessuch as stromal cells and Kuffer cells. Hepatocytes should have highcell viability (>80%), high activity to form bile salts and metabolites(>0.1 nmole/million cells/hr) and high activity (>0.1 nmole/millioncells/hr) to transport bile salts and other substances.

Fifty ml InVitroGRO HT Medium was pre-warmed in a 37° C. water bath. Avial of hepatocyte was removed from a liquid N₂ tank and quickly warmedup in a 37° C. water bath by holding in hand with slow rotation. As soonas the edge of the frozen cells was separated from the wall of the vial,the frozen cells were poured into the pre-warmed HT medium, theremaining cells in the vial were collected using pipette. The tube wascentrifuged at 50 g, 25° C. for 5 minutes, the supernatant was removedand the cell pellet was re-suspended in 8 ml of pre-warmed William Ebuffer, the cell numbers were counted in a hemocytometer. The yield was1×10⁶ cells/ml. The cells were counted in 0.4% Trypan blue (80 μlWilliam E+10 μl Trypan blue stock+10 μl cells). The hepatocyteconcentration was adjusted with William E buffer to meet the objectivesof various experiments.

LC/MS/MS assays: Liquid chromatography was carried out using a Shimadzu(Columbia, Md.) HPLC system consisting of a SCL-10Avp system controller,two LC-10ADvp pumps, a CTC HTC PAL autosampler, a Shimadzu SPD-10ADvp UVdetector and an automated switching valve. The switching valve was usedto divert the column effluent to either waste or to the MS instrument.The Shimadzu HPLC system was used for sample injection and analyteseparation. Each sample was loaded onto a reverse phase column, Waters(Milford, Mass.) Symmetry Shield RP8 5u 2.1 mm×50 mm. The columnchamber's temperature was ambient. The initial HPLC mobile phaseconditions used for separation and elution of analytes comprised 2 mMammonium acetate buffer in water containing 0.1% formic acid and 10%acetonitrile. The flow rate was 0.5 mL/min. The amount of acetonitrilein the mobile phase was ramped linearly up to 40% over a 2-minute periodfollowed by a rapid increase to 95% acetonitrile in 0.5 minutes. Afterholding at 95% acetonitrile for 1.2 minutes, the mobile phase was resetto the initial conditions in 0.1 minute. The analytical column wasequilibrated with the starting mobile phase for 1.2 minutes. The totalrun time for each sample analysis was approximately 5 minutes.

The HPLC elute was injected into an AB Sciex API3000 LC/MS/MS system(Framingham, Mass.) equipped with a Turbo IonSpray source set with adesolvation temperature of 450° C. Nitrogen was used as curtain gas,nebulizer gas, heater gas and collision gas. Data for bile acids andsalts was acquired in the positive ion mode using multiple reactionmonitoring methods (MRM). The ion transitions of the MRM method forspecific detection of GCA, TCA, GDCA, TDCA, GLCA, TLCA, GCDCA and TCDCAwere developed in standard fashion. Carbutamide was used as internalstandard (IS), m/z 272/156. Ionspray voltage was set at 4000 V and thecollision gas (CAD) set at 6. Declustering potential was set at 82, 46,and 49 for GCA, TAC, and IS, respectively. Collision energy was set at25, 33, and 23 eV for GCA, TAC, and IS.

Data analysis: Extracellular concentrations of bile salts weredetermined by LC/MS/MS MRM analysis of the 2000 RPM supernatantfractions post-incubation. Intracellular concentrations of bile saltswere determined by LC/MS/MS MRM of hepatocyte cell lysate obtained afterrupturing of cell membranes post incubation. Bile salt export transportand/or formation activity and test agent percent inhibition werecalculated using the following equations:

${{Bile}\mspace{14mu} {Salt}\mspace{14mu} {Export}\mspace{14mu} {Transport}\mspace{14mu} {Activity}} = \frac{( {{Extracellular}\mspace{14mu} {{Conc}.\mspace{14mu} {Bile}}\mspace{14mu} {Salts}} )}{( {{Hepatocyte}\mspace{14mu} {{Conc}.}} ) \times ( {{Incubation}\mspace{14mu} {Time}} )}$Total  Bile  Salts = Amount  Extracellular + Amount  Intracellular${{Bile}\mspace{14mu} {Salt}\mspace{14mu} {Formation}\mspace{14mu} {Activity}} = \frac{( {{Total}\mspace{14mu} {Bile}\mspace{14mu} {Salts}} )}{( {{Hepatocyte}\mspace{14mu} {Concentration}} ) \times ( {{Incubation}\mspace{14mu} {Time}} )}$${\% \mspace{11mu} {Inhibition}} = \frac{( {{{Activity}\mspace{14mu} {without}\mspace{14mu} {Test}\mspace{14mu} {Agent}} - {{activity}\mspace{14mu} {with}\mspace{14mu} {test}\mspace{14mu} {agent}}} ) \times 100}{( {{Activity}\mspace{14mu} {without}\mspace{14mu} {Test}\mspace{14mu} {Agent}} )}$

Kinetic parameters were calculated using standard Michaelis-Mentenkinetics. IC₅₀ values were determined using Prism software (La Jolla,Calif.) or median-effect equation. [Chou et al., Theoretical basis,experimental design, and computerized simulation of synergism andantagonism in Drug Combination Studies. Pharmacological Reviews 58, 621,2006]

Example 1

Effects of hepatocyte density on the transport and formation of bilesalts: Hepatocytes were prepared in suspension in William E buffer atconcentrations ranging from 0 to 1 million cells/mL. Afterpre-incubation in a 96-well plate for 10 minutes at 37° C. under 5% CO₂,the hepatocyte suspensions were incubated with cholic acid orchenodeoxycholic acid at 100 μM in the final volume of 100 μL at 37° C.under 5% CO₂ for 1 hour. Experiments were carried out in triplicate orduplicate. Suspensions were then centrifuged at 2000 for 15 minutes atroom temperature. The hepatocyte cell pellets were re-suspended inWilliam E buffer and subjected to a standard freeze-thaw procedure andsonication to lyse cell membranes. Separately, the 2000 RPM supernatantsand the cell lysates were mixed with 3× volume acetonitrile, and themixtures centrifuged at 4000 RPM for 20 minutes at 4° C. Thesupernatants were analyzed by LC/MS/MS for glycocholate,glycochenodeoxycholate, taurocholate and/or taurochenodeoxycholate.

The transport and formation of bile salts increased with hepatocyteconcentration starting from 0 cells/mL and increasing to 0.25 millioncells/mL. At hepatocyte concentrations above 0.25 million cells/mL,transport and formation values reached a plateau or decreased (FIG. 3).The transport and formation of bile salts were closely correlated witheach other.

Example 2

Time courses for transport and formation of bile salts in hepatocytes:Hepatocytes at 0.25 million cells/ml were incubated with cholic acid orchenodeoxycholic acid in William E buffer at 100 μM in the final volumeof 100 μL at 37° C. under 5% CO₂ for various time ranging from 0-4hours. The suspensions were then centrifuged at 2000 RPM for 15 minutesat room temperature. The hepatocyte cell pellets were re-suspended inWilliam E buffer and subjected to a standard freeze-thaw process andsonication to lyse cell membranes. Separately, the 2000 RPM supernatantsand the cell lysates were mixed with 3× volume of acetonitrile, and themixtures were centrifuged at 4000 RPM for 20 minutes at 4° C. Thesupernatants were analyzed by LC/MS/MS for glycocholate,glycochenodeoxycholate, taurocholate and/or taurochenodeoxycholate.LC/MS/MS analysis was conducted in duplicate or triplicate.

The transport and formation of bile salts was increased when theincubation time increased from 0-1 hour, but reached a plateau ordecreased when the incubation time was longer than 1 hour (FIG. 4). Thetransport and formation of bile salts were closely correlated with eachother.

Example 3

Effect of bile acid concentration on the transport and formation of bilesalts in hepatocytes: Human hepatocytes at 0.25 million cells/ml wereincubated with cholic acid or chenodeoxycholic acid in William E bufferat various concentrations ranging from 0-1000 μL in the final volume of100 μL at 37° C. under 5% CO₂ for 1 hour. The experiments were carriedout in duplicate or triplicate. After incubation, the suspensions werecentrifuged at 2000-RPM for 15 minutes at room temperature. The cellpellets were re-suspended in William E buffer, and followed byfrozen/thaw and sonication to lyse the hepatocytes. Separately, the2000-RPM supernatants and the cell lysates were mixed with 3× volume ofacetonitrile and the mixtures were centrifuged at 4000-RPM for 20minutes at 4° C. The supernatants were analyzed by LC/MS/MS forglycocholate, glycochenodeoxycholate, taurocholate and/ortaurochenodeoxycholate. LC/MS/MS analysis was conducted in duplicate ortriplicate.

The transport and formation of bile salts were increased when the bileacid concentrations increased, and displayed plateauing or saturation(FIG. 5). The transport and formation of bile salts were closelycorrelated with each other.

Example 4

Effect of chemicals on the transport and formation of bile salts inhepatocytes: Hepatocytes from mouse, rat, dog, monkey and human atconcentrations ranging from 0.1 to 0.25 million cells/mL were incubatedin 96-well plates with 10 μM cholic acid or chenodeoxycholic acid inWilliam E buffer in the presence or absence of test chemicals atconcentrations ranging from 0.01 to 1000 μM at 37° C. under 5% CO₂ for 1hour. After incubation, the 96-well plate was centrifuged at 2000 RPMfor 15 minutes at room temperature. The cell pellets were re-suspendedin William E buffer, and followed by frozen/thaw and sonication to lysethe hepatocytes. Separately, the supernatants and the cell lysates weremixed with 3× volume of acetonitrile, and the mixtures were centrifugedat 4000 RPM for 20 minutes at 4° C. The supernatants were analyzed byLC/MS/MS for the glycocholate, glycochenodeoxycholate, taurocholate andtaurochenodeoxycholate.

Several drugs were tested for the potential modulation of the transportof bile salts in hepatocytes from mouse, rat, dog, monkey and human.Some of the drugs tested are known to cause liver injury and/orcholestasis. The drugs tested include atazanavir, fluconazole,ketoconazole, quinidine, nelfinavir, propranolol, ritonavir, saquinavir,thiotepa, troglitazone, verapamil, vinblastine, crizotinib, quercetin.The results are shown in Tables 1, 2 and 3. The amount of bile saltexport transport inhibition is correlated with the incidence of liverinjury. Species differences were observed in bile salt export transportinhibition. In general, mouse is less sensitive than other species, andmonkey is similar to human in bile salt export transport inhibition.FIG. 6a shows percent inhibition of BSEP activity for the test agenttroglitazone while FIG. 6b shows percent inhibition for the test agentritonavir.

TABLE 1 Inhibition of BSEP activity (transport of glycocholate) byselected drugs in rat, monkey and human hepatocytes. Rat Monkey Human 1μM 10 μM 1 μM 10 μM 1 μM 10 μM Atazanavir B** B A B A B Fluconazole A* AA A A A Ketoconazole A B A B A A Quinidine A A A A A A Nelfinavir A B AB A B Propranolol A A A A A A Ritonavir B B B B B B Saquinavir A B A B AB Thiotepa A A A A A A Troglitazone B B B B B B Verapamil A B A A A AVinblastine A B A A A B Crizotinib A B A A A B Quercetin A A A A A A *A:<50% inhibition, **B: >50% inhibition

TABLE 2 Inhibition of BSEP activity (transport of taurocholate) byselected drugs in mouse, dog and monkey hepatocytes. Mouse Dog Monkey 1μM 10 μM 1 μM 10 μM 1 μM 10 μM Atazanavir A A A B A B Fluconazole A A AA A A Ketoconazole A A A A A B Quinidine A A A A A A Nelfinavir A A A BA B Propranolol A A A A A A Ritonavir A B B B B B Saquinavir A A A B A BThiotepa A A A A A A Troglitazone A A A B A B Verapamil A A A A A AVinblastine A A A A A A Crizotinib A A A B A A Quercetin A A A B A A *A:<50% inhibition, **B: >50% inhibition

TABLE 3 IC50 values for inhibition of BSEP activity by selected drugs inhepatocytes from mouse, rat, dog, monkey and human. Mouse Rat Dog MonkeyHuman Ritonavir B** A* A A A Ketoconazole C*** C B B Rifampicin C B C ATroglitazone C B B B B *A: IC50 < 1 μM; **B: 1 uM < IC50 < 10 μM; ***C:IC50 > 10 μM

1. A kit for assessing a test agent's effect on bile salt exporttransport and/or formation activity comprising one or more bile saltprecursor compounds and one or more hepatocyte preparations, wherein thehepatocyte preparations are used to prepare hepatocyte suspensions forassessing a test agent's effect on bile salt export transport and/orformation activity.
 2. The kit of claim 1 wherein the hepatocytepreparation comprises primary hepatocytes and/or hepatocytes derivedfrom stable cell lines.
 3. The kit of claim 1 wherein the hepatocytepreparation comprises hepatocytes derived from human or animal tissue.4. The kit of claim 3 wherein the hepatocyte preparation compriseshepatocytes derived from human liver tissue.
 5. The kit of claim 3wherein the hepatocytes preparation comprises hepatocytes derived frommouse, rat, dog, rabbit or monkey liver tissue.
 6. The kit of claim 1wherein the hepatocyte preparation comprises hepatocytes derived fromstable cell lines.
 7. The kit of claim 1 wherein the hepatocytepreparation comprises pooled hepatocytes derived from one or more humanliver tissue or one or more animal liver tissue selected from mouse,rat, dog, rabbit and monkey.
 8. The kit of claim 1 wherein the one ormore bile salt precursor compounds comprise individually or incombination cholic acid, chenodeoxycholic acid, deoxycholic acid,lithocholic acid and/or derivatives thereof.
 9. The kit of claim 8wherein the bile acid precursor comprises cholic acid.
 10. The kit ofclaim 8 wherein the bile acid precursor comprises chenodeoxycholic acid.11. The kit of claim 1 wherein the one or more bile salt precursorcompounds comprise fluorescent, stable isotope, or radiolabeled bilesalt precursor compounds selected from cholic acid, chenodeoxycholicacid, deoxycholic acid, lithocholic acid and/or derivatives thereof. 12.A kit for assessing a test agent's effect on bile salt export transportand/or formation activity comprising one or more bile salt precursorcompounds.
 13. The kit of claim 12 wherein the one or more bile saltprecursor compounds comprise individually or in combination cholic acid,chenodeoxycholic acid, deoxycholic acid, lithocholic acid and/orderivatives thereof.
 14. The kit of claim 12 wherein the bile acidprecursor comprises cholic acid.
 15. The kit of claim 12 wherein thebile acid precursor comprises chenodeoxycholic acid.
 16. The kit ofclaim 12 wherein the one or more bile salt precursor compounds comprisefluorescent, stable isotope, or radiolabeled bile salt precursorcompounds selected from cholic acid, chenodeoxycholic acid, deoxycholicacid, lithocholic acid and/or derivatives thereof.
 20. (canceled)
 21. Akit for assessing a test agent's effect on bile salt export transportand/or formation activity comprising one or more fluorescent, stableisotope, or radiolabeled bile salt precursor compounds.
 22. The kit ofclaim 21 wherein the one or more fluorescent, stable isotope, orradiolabeled bile salt precursor compounds comprise fluorescent, stableisotope, or radiolabeled cholic acid, chenodeoxycholic acid, deoxycholicacid, lithocholic acid and/or derivatives thereof.
 23. The kit of claim21 wherein the bile acid precursor comprises fluorescent, stableisotope, or radiolabeled cholic acid.
 24. The kit of claim 21 whereinthe bile acid precursor comprises fluorescent, stable isotope, orradiolabeled chenodeoxycholic acid.